Which method of medication administration provides the client with the greatest first pass effect oral sublingual intravenous subcutaneous?

Definition

Sublingual and buccal medication administration are two different ways of giving medication by mouth. Sublingual administration involves placing a drug under your tongue to dissolve and absorb into your blood through the tissue there. Buccal administration involves placing a drug between your gums and cheek, where it also dissolves and is absorbed into your blood. Both sublingual and buccal drugs come in tablets, films, or sprays.

Your doctor may prescribe sublingual or buccal drugs under any of the following circumstances:

the drug needs to get into your system quickly
you have trouble swallowing medication
the medication doesn’t absorb very well in the stomach
the effects of the drug would be decreased by digestion

The cheek and area under the tongue have many capillaries, or tiny blood vessels. There, drugs can be absorbed directly into the bloodstream without going through your digestive system.

Sublingual or buccal forms of drugs have their advantages. Because the medication absorbs quickly, these types of administration can be important during emergencies when you need the drug to work right away, such as during a heart attack.

Further, these drugs do not go through the digestive system, so they aren’t metabolized through your liver. This means you may be able to take a lower dose and still get the same results.

Another advantage is that you don’t have to swallow the drug. Drugs that are absorbed under the tongue or between the cheek and gum can be easier to take for people who have problems swallowing pills.

On the other hand, sublingual and buccal drugs also have some disadvantages. Eating, drinking, or smoking, can affect how the drug is absorbed and how well it works. Also, these forms don’t work for drugs that need to be processed slowly by your system, such as extended-release formulations. Any open sores in your mouth can also become irritated by the medication.

Tell your doctor if you smoke or have open sores in your mouth if they prescribe sublingual or buccal medication for you. Also ask your doctor how long you need to wait before you can drink and eat after taking the medication. For some of these drugs, you can’t drink, swallow, eat, or smoke for some time. Sometimes these drug forms can irritate your mouth. Tell your doctor right away if this happens to you.

We usually divide routes of drug administration that produce systemic effect in Enteral or Parenteral. From Greek Enteros = Intestine and Para = Beside. Thus either it passes through the intestinal tract or it avoids it. This is extremely important as some drugs are poorly absorbed in the intestines, others are well absorbed however are metabolized almost completely by first-pass effect.

Enteral[edit | edit source]

Are entering the intestinal tract.

Oral[edit | edit source]

Given by mouth is the most common route of drug administration, however it also the one with the most complicated pathway to the target tissues. Most drugs are absorbed in the intestinal tract by passive transfer and usually end up in the portal circulation encountering the liver and thus high chance of passing the first-pass effect.

Rectal[edit | edit source]

Rectal administration can be used for producing local or systemic effects. It is quite unreliable however. 75% of drainage of the rectal region bypasses the portal circulation and thus minimizing first-pass effect. The inferior and middle rectal veins are linked to the systemic circulation whereas the superior rectal vein joins the inferior mesentering vein and from there onto the portal vein. It can be very useful during vomiting and in patients that are unable to take medications by mouth.

Sublingual[edit | edit source]

Sublingual administration can be classified into Parenteral as well, it does not enter the lower GastroIntestinal Tract, however it is placed under the tongue thus going oral. The drug diffuses into the capillary network and enters the system circulation directly. It is very rapidly absorbed, low infection risk, avoiding the rough environment of the GIT and no first-pass metabolism.

Parenteral[edit | edit source]

This route of administration avoids the GIT, and is used for drugs that are poorly absorbed or unstable in the GIT, for unconscious patients and when acute onset is required.

Intravenous [IV][edit | edit source]

Injection straight into the systemic circulation is the most common parenteral route. It is the fastest and most certain and controlled way. It bypasses absorption barriers and first-pass metabolism. It is used when a rapid effect is required, continuous administraction and large volumes. The disadvantages are that one cannot recall injected drugs, introduction of bacteria through contamination as well as too rapid delivery or too high concentration may produce strong adverse effects.

Intramuscular [IM][edit | edit source]

Produces a faster effect than oral administration, however the rate of absorption depends greatly on the site of injection and on local blood flow. The drug can be aqueous solutions or depot preparations [in a form of ester or salt]. The absorption of the aqueous is fast and the depot form is slow. The advantage of the depot form is that it can provide a sustained dose over an extend period of time.

Subcutaneous [SC][edit | edit source]

The absoroption of subcutaneous injections is slower than that of IV route and it needs absorption similar to Intramuscular injection. However it minimizes the risks associated with IV injections.

Other routes[edit | edit source]

Inhalation

This route is used for gaseous drugs or those that can be dispersed in an aerosol, and is produces an effect almost as fast as with IV. It provides rapid delivery across the mucous membranes of the respirateory tract. It is used for asthmatic drugs, and anesthetics.

Intranasal

Drug administration directly into the nose. Includes agents such as nasal decongestants or cocaine by abusers.

Topical

As the name implies, it is applied where and when a local effect of the drug is desired.

Transdermal

Drug administration through the skin. It can achieve systemic effects but rate of absorption can vary markedly depending on the physical characteristics of the skin at application.

Intrathecal / Intravetricular

Drug administration into the cerebrospinal fluid [CSF]. Used in cases of CNS cancers, cryptococcal meningitis etc.

Links[edit | edit source]

Bibliography[edit | edit source]

FINKEL, CLARK, CUBEDDU, HARVEY, CHAMPE,, et al. Lippincott's Illustrated Reviews: Pharmacology. 4. edition. 2009. ISBN 978-1605472003.

HUMPHREY, RANG, DALE, RITTER, FLOWER, HENDERSON,, et al. Rang and Dale's Pharmacology. 7. edition. 2007. ISBN 978-0702034718.

Which route of drug administration is most likely to first

Oral route of drug administration is most likely to lead to the first-pass effect.

Which drug has a high first

Notable drugs that experience a significant first-pass effect are buprenorphine, chlorpromazine. cimetidine, diazepam, ethanol [drinking alcohol], imipramine, insulin, lidocaine, midazolam, morphine, pethidine, propranolol, and tetrahydrocannabinol [THC].

Which route of administration is the fastest and most effective way to deliver a drug?

The route by which the medicines are directly introduced into the bloodstream through a vein is known as intravenous route of administration. The intravenous route is considered to be the fastest route of drug administration. The injections and the infusions are administered by this route have 100% bioavailability.

Does sublingual avoid first pass?

Sublingual administration of drug refers to the placement of drug under the tongue [Rehfeld et al., 2017]. The sublingual route bypasses the first-pass metabolism and hence facilitates rapid absorption of the drug into the systemic circulation.